三种手术方式治疗原发性急性闭角型青光眼疗效的临床观察

Three surgical methods in the treatment of primary acute angle-closure glaucoma efficacy clinical observation

目的观察原发性急性闭角型青光眼三种手术方式的临床疗效及并发症,探讨手术适应证的选择。方法回顾性分析我院收治的原发性急性闭角型青光眼患者192例(200只眼),分别行小梁切除术(组1),超声乳化白内障吸除联合人工晶状体植入术(组2),超声乳化白内障吸除联合人工晶状体植入联合小梁切除术(组3),比较三种手术的临床疗效及术中术后并发症,术后随访4～20个月,平均(7.6±2.8)个月。结果三组术后眼压均较术前明显降低(P<0.01),随访期间眼压控制率分别为90.2%、100%、94.6%;超声乳化组与联合手术组术后视力较术前提高(P<0.01),前房深度较术前加深(P<0.01),小梁切除术组视力、前房深度较术前变化不明显(P>0.05)。主要并发症为小梁切除术组后行白内障手术患者9只眼,眼压再次升高需药物控制的小梁切除术组5例,联合手术组2例。结论在严格控制手术适应证的前提下,超声乳化白内障吸除联合人工晶状体植入术可以作为治疗原发性急性闭角型青光眼主要手术方式之一。

Objective To observe the clinical efficacy and complications of three surgical meth- ods for primary acute angle-closure glaucoma and explore the choice of surgical indications. Methods Retrospect analyses of 192 patients（200 eyes） with primary acute angle-closure glaucoma. According to surgical methods, all these eyes were separated into three groups which were simple trabeculeetomy group （groupl）, phacoemulsification with posterior chamber intraoeular lens （IOL） implantation group （group2）, and tri-combined operations of phacoemulsification and poste- rior chamber IOL implantation with trabeculectomy group（group3）. After surgery, three surgi- cal methods were compared in clinical efficacy and complications during follow up period of 4-20 months, （7.6±2.8） months. Results The postoperative intraocular pressures （IOP） were decreased significantly in all groups （P〈0.01）. During follow-up time, IOP control rate were sepa rately 90.2%,100% and 94.6%. Postoperative visual acuity of eyes were improved in group 2 and group 3 （P〈0.01）, meanwhile anterior chamber depth（ACD） increased （P〈0.01）. The postoperative vision and ACD did not change significantly in group 1 （P〈0.05）. Major complica- tions： nine patients underwent cataract surgery after trabeculectomy in group 1. Five eyes were requiring medication to control intraocular pressure after surgery in simple trabeculectomy group, but only two eyes in combined surgery group. Conclusion In the strict control of the premise of the indications for surgery, phacoemulsification with posterior chamber IOL implantation can be used as one of the treatments of primary acute angle-closure glaucoma surgery.